A Minimally Invasive Transmuscular Approach to Far-lateral L5-S1 Level Disc Herniations

Kotıl, Kadır; Akçetin, Mustafa Ali; Bılge, Turgay

doi:10.1097/01.bsd.0000211268.43744.2a

Cited by 48 publications

(31 citation statements)

References 29 publications

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“…11,[19][20][21] Although far-lateral disc herniations at L5-S1 are very rare, accounting for 2%-4% of all symptomatic lumbar disc herniations, 1,12 the incidence of compression of the L-5 nerve at the extraforaminal region of L5-S1 is probably higher than that accounted for by disc herniations alone. This is due to the unique anatomical features of the L5-S1 extraforaminal region.…”

Section: Discussionmentioning

confidence: 99%

“…9,12,27,33 The cause of the dysesthesias, although not definitively proven, has been attributed variously to the manipulation of the dorsal root ganglion, thermal injury due to use of cautery, and even avulsion of the dorsal ramus from the ganglion. 9,24 The incidence of postoperative dysesthesias in the present series was 28.8%, which resolved in the majority of patients within a month.…”

Section: Discussionmentioning

confidence: 99%

“…11,12,14,19,21,25,30 An approach using a tubular retractor overcomes several limitations of conventional midline, as well as far-lateral, muscle-splitting approaches. One of the main limitations is the restricted field of view that makes it essential to have a thorough understanding of the regional anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,5,17,18,25,30,32 Extraforaminal disc herniations at L5-S1 are even more unusual, accounting for 2%-4% of all disc hernations. 1,12 Extraforaminal or farlateral disc herniations directly compress the dorsal root ganglion and thus produce severe clinical symptoms and a higher incidence of neurological deficits as compared with classic posterolateral herniations. 25 The extraforaminal zone at L5-S1 has several unique anatomical features.…”

mentioning

confidence: 99%

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Extraforaminal compression of the L-5 nerve root at the lumbosacral junction: clinical analysis, decompression technique, and outcome

Lee¹,

Kang²,

Srikantha

et al. 2014

SPI

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Object Extraforaminal compression of the L-5 nerve encompasses multiple pathological entities and may result from disc herniations as well as bony (osteophytes or sacral ala) or ligamentous (sacroiliac ligament and lumbosacral band) compression. Several other factors, such as disc space collapse or coronal wedging, can also contribute to narrowing of the extraforaminal space. The extraforaminal space at L5–S1 has unique anatomical features compared with the upper lumbar levels, which makes surgical access to this region difficult. Minimally invasive techniques offer easier access to the region. The purpose of this study was to analyze the contributing factors for extraforaminal compression of the L-5 nerve and assess clinical outcome following surgical decompression. Methods Fifty-two consecutive patients who underwent a minimally invasive far-lateral approach for extraforaminal compression of the L-5 nerve were retrospectively analyzed for clinical data, outcomes, and imaging features (type of disc prolapse, coronal wedging, degree of disc and facet degeneration, facet tropism, foraminal stenosis, osteophytes, and adjacent-level disease). The authors describe the surgical technique used in this study. Results The mean age of the patient sample was 57 years. Sixteen patients each had an extraforaminal ruptured disc or contained protrusion, and the remaining 20 patients had disc protrusions extending into the foraminal region or the lateral recess. Associated foraminal stenosis was found in 38.5%, and adjacent-level stenosis was noted in 22 cases (42.3%) and spondylolisthesis in 4 (7.7%). Osteophytes were noted in 18 cases. A coronal wedging angle ≥ 3° was found in 46.2%, and the laterality of wedging corresponded to the symptomatic side in 91% of cases. Fifteen patients (28.8%) complained of postoperative dysesthesias, which completely resolved in all cases within 6 months. The incidence of dysesthesias was more common in the ruptured disc group. There were no differences in clinical outcome among the different types of disc prolapses. The mean preoperative and postoperative visual analog scale scores were 7.6 and 3.6, respectively. The mean preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were 6.4 and 13.8, respectively. The mean JOA recovery rate was 86.1%. According to the Macnab functional grading system, 96% of the patients had excellent or good grades at follow-up. Conclusions A minimally invasive far-lateral approach to L5–S1 requires a good understanding of the regional anatomy and can provide good to excellent clinical results in properly selected cases. This approach is effective in decompressing the far-lateral and foraminal zones. Adequate preoperative diagnosis and tailoring the surgical procedure to address the relevant compressive element in each case is essential to achieving good clinical results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Extraforaminal compression of the L-5 nerve root at the lumbosacral junction: clinical analysis, decompression technique, and outcome

Lee¹,

Kang²,

Srikantha

et al. 2014

SPI

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“…It has limited applicability at the L5/S1 level because of obstruction by the iliac crests (14). Potential complications, as with other approaches, include damage to the root at the level of surgery, dural tear, residual sequestered disc, leakage of cerebrospinal fluid and neuropathic limb pain attributed to manipulation of the dorsal root ganglion (1,15,16).…”

Section: Introductionmentioning

confidence: 99%

Far lateral microdiscectomy: a minimally-invasive surgical technique for the treatment of far lateral lumbar disc herniation

Phan¹,

Dunn²,

Rao³

et al. 2016

J. Spine Surg.

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Lumbar disc herniation arises when the annulus fibrosus of the vertebral disc fails, thus allowing displacement of the nucleus pulposus and other tissue. The term far lateral is used variably in the literature and usually refers to an extraforaminal displacement in the peridiscal zone peripheral to the sagittal plane of the most lateral part of the pedicle at the same level. Non-surgical treatments of far lateral disc herniation include physical therapy, anti-inflammatory medication, and corticosteroid injections. Where these conservative measures fail, surgical intervention may be required. Several surgical techniques for the treatment of far lateral herniations have been investigated, including total or medial facetectomy, laminectomy, hemilaminectomy, approaches through the pars interarticularis, and lateral approaches between the transverse processes via the intertransverse muscle and ligament. We present our far lateral microdiscectomy technique which involves accessing the nerve root lateral to the foramen through a small paramedian incision and use of an operating microscope. Far lateral microdiscectomy offers the prospect of better long-term results than other surgical techniques because of less extensive muscle dissection and preservation of the integrity of the facet joint.

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Musculoskeletal Features of Hypermobility and Their Management

Beighton

Grahame

Bird

2011

Hypermobility of Joints

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A Minimally Invasive Transmuscular Approach to Far-lateral L5-S1 Level Disc Herniations

Cited by 48 publications

References 29 publications

Extraforaminal compression of the L-5 nerve root at the lumbosacral junction: clinical analysis, decompression technique, and outcome

Extraforaminal compression of the L-5 nerve root at the lumbosacral junction: clinical analysis, decompression technique, and outcome

Far lateral microdiscectomy: a minimally-invasive surgical technique for the treatment of far lateral lumbar disc herniation

Musculoskeletal Features of Hypermobility and Their Management

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